Linda Gromko, MD is a family physician whose husband, Steve Williams, received five Home Hemodialysis treatments per week beginning in 1/08. He switched to Home Peritoneal Dialysis in 1/11. Sadly, Steve died in April 2011 - one week after a leg amputation. Dr. Gromko's blog explores issues of treating Renal Failure at home, making the treatments more user-friendly, and supporting the all-important caregiver in the family on Home Dialysis.

Thursday, April 7, 2011

Waiting for Steve's Amputation

"All things considered," as Steve often says, we've been doing reasonably well. He was admitted to the hospital briefly in March for the family respiratory infection: probably a viral pneumonitis. While it hung on for a while, Steve has made excellent progress.

We'd been back to our weekly dates of dinner and a movie via Access bus. On one such trip - March 13 to be exact - Steve had an elevator door close on his left foot. That night, I discovered a quarter-sized blood blister on his left big toe. Since I dress him, I know it hadn't been there before; it was an elevator bite!

Steve had a routine podiatry appointment scheduled for the next day; he has had a tiny stasis ulcer on his left middle toe for many months. The podiatrist looked at Steve's feet and referred him to the wound care center. A vascular mapping ultrasound had already been scheduled, ironically, before the elevator incident.

In the two to three days before the mapping exam, Steve's left foot worsened considerably. The big toe and the two adjacent toes were rapidly turning black.

When Dr. Watson, Steve's vascular surgeon evaluated him on March 30, he said, "The leg will have to go."

An amputation! We've always known that a stubbed toe in a diabetic could lead to an amputation. But here we were - discussing Steve's amputation! A below-the-knee amputation would afford a greater possibility of walking sometime in the future.

And walking allows for the possibility of another kidney transplant even further down the road. Steve is simply not ready to let that opportunity go - at least not now.

So Steve is in the Operating Room, and I'm writing. Support from friends has flowed in; so have all the intentional and unintentional amputation puns.

I believe he will get through this surgery fine. An hour-and-a-half case! Barely time for a cut, color and perm!

But the implications are weighty. Mortality figures for renal failure patients with amputations run over 50% during the year of amputation. Of course, most of that mortality is attributable to cardiovascular causes. Steve's heart has been practically rebuilt, and he's had no new symptoms of worry.

But we do worry, of course. Steve and I have framed this new development as the beginning of a new chapter. Steve's Rehab specialist, Dr. Tempest, underscored only yesterday the vast improvements he's made since his visit in October.

We're in there. And if there's one thing that has proved itself again and again, it's been the strength and resilience of Steve Williams.